REMOTE COUNSELING RESPONSE FOR GENOCIDE SURVIVORS

The Context - Since March 2020 when the country first experienced the first COVID-19 lockdown, the rate of COVID-19 infection and related mortalities are at their highest. Infection and mortality of vulnerable genocide survivors especially widows is much higher, as well the impact on the mental health and livelihoods of the genocide survivors. The government of Rwanda has set up strong measures to contain the spread and treatment of patients infected by COVID-19. However, with the increasingly high numbers of infection and severe sickness, health care services are overwhelmed by the numbers and as COVID-19 takes longer, the of risk of infection and death from COVID-19 by the survivors of the genocide especially widows, increases, livelihoods insecurity, and mental health challenges multiply.

It established that the elderly population and other people with preexisting conditions are most vulnerable to COVID 19 infection have a high probability of succumbing to COVID related death compared to those without pre-existing conditions or of young age. As a result, we are currently witnessing a phenomenal rise of COVID-19 delta valiant infections, and death rates of vulnerable survivors of the genocide especially widows.

Genocide survivors suffer from physical and psychological wounds which fall in the definition of pre-existing conditions. Some have HIV/AIDS, some have history of Tuberculosis related to HIV /AIDS, and some are diabetic, high blood pressure, hepatitis and asthma, and most of them are unescapably elderly. Overall, 1623 members of AVEGA suffer from incurable diseases. Worse still, survivors suffer from mental health challenges especially PTSD, among others. All the above compounded, make vulnerable genocide survivors a high risk category for COVID-19 compared to the rest of the population.

Statistics from the 2018 Rwanda demographic Health Survey (DHS) indicated that 28% of Rwandans had PTSD, while 38% suffered from extreme grief. DHS also indicated that mental health challenges are highly prevalent among survivors of the genocide compared to the rest of the general population. The pandemic has adverse effects on the general population at large, but the impact is even worse for the survivors of the genocide against the Tutsi.

AVEGA has been providing mental health services to widows of the genocide against the Tutsi since 1997 when it started. Overall, more than 2500 widows of the Genocide live with continuing PTSD and require ongoing mental health services out of whom 613 are enrolled into our mental health program benefiting from group and individual counselling services, among others. Preliminary data from a rapid assessment conducted by AVEGA indicates that 270 survivors of the genocide have contracted COVID 19, while unfortunately 30 have succumbed to COVID-19. A compressive study on the impact of COVID -19 of on survivors of the genocide will be conducted to determine the extent of infection, death, mental health and socioeconomic wellbeing of the survivors.

The situation for vulnerable genocide survivors is exacerbated by the fact that they largely do not have a family support system. As such, most survivors especially widows majority of whom are childless are not only vulnerable because they elderly or because they have pre-existing conditions, they are also vulnerable because they do not have a family / people around them to take care of them in home settings, including when their health deteriorates and need to be taken to hospital.

As such a number of factors are immensely impacting on survivors resulting from isolation and loneliness due to the lockdown; the lack of a family support system to fall back to, general distress related to the uncertainty and instability around COVID-19; disruption of the livelihoods of the survivors because they are not able to work, resulting in food shortages; trauma which is being elicited by the uncertainty of the situation causing flashbacks and other PSTD symptoms, are exacerbating the mental health conditions of vulnerable genocide survivors and contributing to the onset of new mental health problems among the survivors of the genocide. The issue is how we manage and react to the stressful situation unfolding so rapidly in our communities, in particular the toll it has on vulnerable survivors.

The Approach (What needs to be done to done) - While AVEGA has been providing psychological support through counselling groups, this is no longer possible due to the current crisis and lockdown. As such there is need to provide counselling services remotely, principally through phone-based communication, and comprehensively follow up to provide current reports on mental health issues. In addition to the online counselling services, AVEGA will be through the helpline, will be able to identify livelihood challenges of vulnerable beneficiaries refer them for support including emergency hardship and nutritional support. This proposal builds on our successful model of providing counselling through both the free helpline and other phone-based counselling to survivors.

The project will focus on 4 principal activities, which follow a logical approach: 1) First, we will raise awareness about our available psychological services and mental health issues affecting survivors principally through radio; 2) Second, we will deliver support, in the form of access to phone counselling, hardship support and limited home visits by community psychosocial workers to those most in need; 3) Third, we will monitor and learn from the work as it is conducted to continuously adapt and strengthen the helpline counselling delivery system.

Project Objectives and Related Activities

Objective/Activity 1: Raising awareness of the availability of mental health support

We will focus awareness of the phone-based counselling program all over the country, achieved through multiple channels, including; 1) a radio advert that will be produced and airtime will be secured to broadcast how mental health support can be accessed through the toll-free lines to a broad audience at regular times.

Objective/Activity 2: Delivering mental health support and emergency assistance

The key entry point for the project is providing phone-based counselling and case follow up. We intend to set up and operate 5 toll-free lines; one for each province operated by 10 professional counsellors.

5. Beneficiaries and geographical reach- We expect to reach at least 3000 vulnerable survivors with one-to-one support through the toll-free lines from the 5 counsellors and in-person follow-up by community psychosocial workers and over 30,000 other vulnerable persons nationwide who will get benefit through the radio counselling programs.

6. Sustainability and Scalability - The project has the potential to be a scalable model of emergency support, and there will be immediate feedback by participants on its impact which will be collected by the counsellor’s active in the project. Dependent on the level of demand for the phone-based counselling, then there is the option of scaling up that component of the project through increasing the number of counsellors (and toll-free lines) so that more vulnerable persons can access the service at this time, or in future.

The project will immediately enhance the capacity of AVEGA to provide the emergency assistance required by the most vulnerable survivors at this critical time, and sustain the organization’s capacity to extend its reach at the point that the crisis is over as we can transition the mental health emergency support to a more sustained in-person group approach where required.